Treatment and survival from breast cancer: the experience of patients at South Australian teaching hospitals between 1977 and 2003

Rationale  Treatment guidelines recommend a more conservative surgical approach than mastectomy for early stage breast cancer and a stronger emphasis on adjuvant therapy. Registry data at South Australian teaching hospitals have been used to monitor survivals and treatment in relation to these guide...

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Bibliographic Details
Published in:Journal of evaluation in clinical practice 2007-04, Vol.13 (2), p.212-220
Main Authors: Luke, Colin, Gill, Grantley, Birrell, Stephen, Humeniuk, Vlad, Borg, Martin, Karapetis, Christos, Koczwara, Bogda, Olver, Ian, Penniment, Michael, Pittman, Ken, Price, Tim, Walsh, David, Kiat (Eric) Yeoh, Eng, Roder, David
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
breast cancer
Breast Neoplasms - therapy
Female
Hospitals, Teaching
Humans
Middle Aged
Patients
Proportional Hazards Models
Registries
South Australia
Survival Analysis
survival trends
treatment patterns
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Summary:Rationale  Treatment guidelines recommend a more conservative surgical approach than mastectomy for early stage breast cancer and a stronger emphasis on adjuvant therapy. Registry data at South Australian teaching hospitals have been used to monitor survivals and treatment in relation to these guidelines. Aims and objectives  To use registry data to: (1) investigate trends in survival and treatment; and (2) compare treatment with guidelines. Methods  Registry data from three teaching hospitals were used to analyse trends in primary courses of treatment of breast cancers during 1977–2003 (n = 4671), using univariate analyses and multiple logistic regression. Disease‐specific survivals were analysed using Kaplan–Meier product limit estimates and multivariable Cox proportional hazards regression. Results  The 5‐year survival was 79.9%, but with a secular increase, reaching 83.6% in 1997–2003. The relative risk of death (95% confidence limits) was 0.74 (0.62, 0.88) for 1997–2003, compared with previous diagnoses, after adjusting for tumour node metastasis stage, grade, age and place of residence. Treatment changes included an increase in conservative surgery (as opposed to mastectomy) from 51.7% in 1977–1990 to 76.8% in 1997–2003 for stage I (P 
ISSN:1356-1294
1365-2753
DOI:10.1111/j.1365-2753.2006.00678.x